Les déterminants du comportement de recours au tradipraticien en milieu urbain africain: Résultats d'une enquête de ménage menée à Kinshasa, Congo

This study analyses the determinants of choice of the populations for the traditional practitioner through a survey of behavior of families in a representative sample of 1000 household in the health zones of Kinshasa, Congo in 1997. For the last episode of illness, the respondents resorted to 7 types of care: health centre (37%), the health clinic private (26.5%), pharmaceutical self-medication (23.9%), traditional healer (21%), traditional self-medication (16.9%), the associated polyclinic (16.7%) and a referral hospital (10.4%). Past logistics have shown more resort to the health centre (p<0,05) when looking for the quality of care. So, when looking for the presence of a doctor and the existence of a ‘convention’ with the household people resorts to the conventional polyclinic. On the other hand, concern about the geographical proximity in relation with the household’s residence, people calls for using the private clinic. When looking for the existence of the polyvalent services and acceptable prices, the health centre is resorted rather than other health structures. People who searched for a solution to a particular type of disease chose primarily the traditional practitioner.
In conclusion, the results of this study show that if people choose the traditional practitioner, it is because they consider him as the only appropriate for the type of concerned disease. The presence of a traditional practitioner, “specialized” in the health care of specific types of disease, in the structure of health is a great asset to the acceptability of the first level of primary health care in Kinshasa.
This study suggests that the traditional practitioner can play a complementary role in the realization of primary healthcare, even in urban areas. It is important to study the possibility of integrating the traditional health care in the minimum package of activities. Moreover, considering the low buying power of the city’s inhabitants and the previous existence of solidarity and the structures of health insurance tontines, “convention” providing reduction of health care cost, under the leadership of the local communities, should be integrated into the organization of the urban health care system.